CHAPTER 8 Patient Assessment National EMS Education Standard Competencies Assessment Applies scene information and patient assessment findings (scene size-up, primary and secondary assessment, patient history, and reassessment) to guide emergency management. Scene Size-up ■ Scene safety (pp 255–256) ■ Scene management ● Impact of the environment on patient care (p 255) ● Addressing hazards (p 256) ● Violence (p 256) ● Need for additional or specialized resources (pp 258–259) ● Standard precautions (pp 257–258) ● Multiple patient situations (p 257) Primary Assessment ■ Primary assessment for all patient situations (pp 261–278) ● Level of consciousness (pp 262–265) ● ABCs (pp 265–274) ● Identifying life threats (pp 274–275) ● Assessment of vital functions (pp 262–265) ● Initial general impression (p 261) ■ Begin interventions needed to preserve life (pp 274–275) ■ Integration of treatment/procedures needed to preserve life (pp 275–278) History Taking ■ Determining the chief complaint (pp 280–282) ■ Mechanism of injury/nature of illness (pp 256–257) ■ Associated signs and symptoms (pp 280–282) ■ Investigation of the chief complaint (pp 280–282) ■ Past medical history (pp 280–282) ■ Pertinent negatives (p 282) Secondary Assessment ■ Performing a rapid full-body scan (pp 291–296) ■ Focused assessment of pain (pp 291, 296–304) ■ Assessment of vital signs (pp 289–291) Techniques of physical examination ■ Respiratory system (p 296) ● Presence of breath sounds (p 266) ■ Cardiovascular system (pp 296–301) ■ Neurologic system (p 301) ■ Musculoskeletal system (pp 301–302) ■ All anatomic regions (pp 302–304) Monitoring Devices ■ Obtaining and using information from patient monitoring devices including (but not limited to) ● Pulse oximetry (pp 289–290) ● Noninvasive blood pressure (p 290) Reassessment ■ How and when to reassess patients (p 306) ■ How and when to perform a reassessment for all patient situations (p 306) Knowledge Objectives 1. Identify the components of the patient assessment process and explain how the different causes and presentations of emergencies will affect how each step is performed by the EMT. (p 253) 2. Discuss some of the possible environmental, chemical, and biological hazards that may be present at an emergency scene, ways to recognize them, and precautions to protect personal safety. (pp 255–256) 3. Discuss the steps EMTs should take to survey a scene for signs of violence and protect themselves and bystanders from real or potential danger. (p 256) 4. Describe how to determine the mechanism of injury (MOI) or nature of illness (NOI) at an emergency and the importance of differentiating trauma patients from medical patients. (pp 256–257) 5. List the minimum standard precautions that should be followed and personal protective equipment (PPE) that should be worn at an emergency scene, including examples of when additional precautions would be appropriate. (pp 257–258) 6. Explain why it is important for EMTs to identify the total number of patients at an emergency scene and how this evaluation relates to determining the need for additional or specialized resources, implementation of the incident command system (ICS), and triage. (pp 258–259) 7. Describe the principal goals of the primary assessment process: to identify and treat life-threats and to determine if immediate transport is required. (pp 261–278)
Assessment Applies scene information and patient assessment fi ndings (scene size-up, primary and secondary assessment, patient history, and reassessment) to guide emergency management.
Scene Size-up � Scene safety (pp 255–256)
� Scene management
� Impact of the environment on patient care (p 255)
� Addressing hazards (p 256)
� Violence (p 256)
� Need for additional or specialized resources (pp 258–259)
� Standard precautions (pp 257–258)
� Multiple patient situations (p 257)
Primary Assessment � Primary assessment for all patient situations (pp 261–278)
� Level of consciousness (pp 262–265)
� ABCs (pp 265–274)
� Identifying life threats (pp 274–275)
� Assessment of vital functions (pp 262–265)
� Initial general impression (p 261)
� Begin interventions needed to preserve life (pp 274–275)
� Integration of treatment/procedures needed to preserve life (pp 275–278)
History Taking � Determining the chief complaint (pp 280–282)
� Mechanism of injury/nature of illness (pp 256–257)
� Associated signs and symptoms (pp 280–282)
� Investigation of the chief complaint (pp 280–282)
� Past medical history (pp 280–282)
� Pertinent negatives (p 282)
Secondary Assessment � Performing a rapid full-body scan (pp 291–296)
� Focused assessment of pain (pp 291, 296–304)
� Assessment of vital signs (pp 289–291)
Techniques of physical examination � Respiratory system (p 296)
� Presence of breath sounds (p 266)
� Cardiovascular system (pp 296–301)
� Neurologic system (p 301)
� Musculoskeletal system (pp 301–302)
� All anatomic regions (pp 302–304)
Monitoring Devices � Obtaining and using information from patient monitoring devices
including (but not limited to)
� Pulse oximetry (pp 289–290)
� Noninvasive blood pressure (p 290)
Reassessment � How and when to reassess patients (p 306)
� How and when to perform a reassessment for all patient situations (p 306)
Knowledge Objectives 1. Identify the components of the patient assessment process and
explain how the different causes and presentations of emergencies will affect how each step is performed by the EMT. (p 253)
2. Discuss some of the possible environmental, chemical, and biological hazards that may be present at an emergency scene, ways to recognize them, and precautions to protect personal safety. (pp 255–256)
3. Discuss the steps EMTs should take to survey a scene for signs of violence and protect themselves and bystanders from real or potential danger. (p 256)
4. Describe how to determine the mechanism of injury (MOI) or nature of illness (NOI) at an emergency and the importance of differentiating trauma patients from medical patients. (pp 256–257)
5. List the minimum standard precautions that should be followed and personal protective equipment (PPE) that should be worn at an emergency scene, including examples of when additional precautions would be appropriate. (pp 257–258)
6. Explain why it is important for EMTs to identify the total number of patients at an emergency scene and how this evaluation relates to determining the need for additional or specialized resources, implementation of the incident command system (ICS), and triage. (pp 258–259)
7. Describe the principal goals of the primary assessment process: to identify and treat life-threats and to determine if immediate transport is required. (pp 261–278)
8. Explain the process of forming a general impression of a patient as part of primary assessment and the reasons why this step is critical to patient management. (p 261)
9. Explain the importance of assessing a patient’s level of consciousness (LOC) to determine altered mental status and give examples of different methods used to assess alertness, responsiveness, and orientation. (pp 262–265)
10. Describe the assessment of airway status in patients who are both responsive and unresponsive and give examples of possible signs and causes of airway obstruction in each case as well as the appropriate EMT response. (pp 265–266)
11. Describe the assessment of a patient’s breathing status, including the key information the EMT must obtain during this process and the care required for patients who have both adequate and inadequate breathing. (pp 266–269)
12. List the signs of respiratory distress and respiratory failure. (p 269)
13. Describe the assessment of a patient’s circulatory status, including the different methods for obtaining a pulse and appropriate manage-ment depending on the patient’s status. (pp 270–272)
14. Explain the variations required to obtain a pulse in infant and child patients as compared with adult patients. (pp 270–272)
15. Describe the assessment of a patient’s skin color, temperature, and condition, providing examples of both normal and abnormal fi ndings and the information this provides related to the patient’s status. (pp 272–274)
16. Discuss the process of assessing for and methods for controlling external bleeding. (p 274)
17. Discuss the steps used to identify and subsequently treat life-threatening conditions that endanger a patient during an emergency. (pp 274–275)
18. List the steps the EMT should follow during the rapid scan of a trauma patient, including examples of abnormal signs and appropriate related actions. (pp 275–277)
19. Explain the process for determining the priority of patient care and transport at an emergency scene and give examples of conditions that necessitate immediate transport. (pp 275, 277–278)
20. Discuss the importance of protecting a trauma patient’s spine and identifying fractured extremities during patient packaging for transport. (pp 277–278)
21. Discuss the process of taking a focused history, its key components, and its relationship to the primary assessment process. (pp 280–281)
22. Describe examples of different techniques an EMT may use to obtain information from patients during the history taking process. (pp 280–287)
23. Discuss different challenges an EMT may face when taking a patient history on sensitive topics and strategies they may use to facilitate each situation. (pp 282–287)
24. Explain the purpose of performing a physical exam during secondary assessment, its components, special patient considerations, and methods for determining which aspects of the physical examination will be used. (pp 289–304)
25. Describe the purpose of a full-body scan and list the steps used during this process. (pp 291–295)
26. Explain situations in which patients may receive a focused assessment and then give examples by body system of what each focused assessment should include based on a patient’s chief complaint. (pp 291, 296–304)
27. List normal blood pressure ranges for adults, children, and infants. (pp 296–301)
28. Explain the importance of performing a reassessment of the patient and the steps in this process. (p 306)
Skills Objectives 1. Demonstrate how to use the AVPU scale to test for patient
responsiveness. (p 262)
2. Demonstrate how to evaluate a patient’s orientation and document his or her status correctly. (pp 262–264)
3. Demonstrate how to test pupil reaction in response to light in a patient and document his or her status correctly. (pp 264–265)
4. Demonstrate the techniques for assessing a patient’s airway and correctly obtain information related to respiratory rate, rhythm, quality/character of breathing, and depth of breathing. (pp 265–269)
5. Demonstrate how to assess a radial pulse in a responsive patient and an unresponsive patient. (pp 270–272)
6. Demonstrate how to assess a carotid pulse in an unresponsive patient. (pp 270–272)
7. Demonstrate how to palpate a brachial pulse in a child who is younger than 1 year (or a manikin). (pp 270–272)
8. Demonstrate how to obtain a pulse rate in a patient. (pp 270–272)
9. Demonstrate how to assess capillary refi ll in an adult or child older than 6 years. (pp 273–274)
10. Demonstrate how to assess capillary refi ll in an infant or child younger than 6 years; explain variations that would be required when assessing a newborn. (pp 272–274)
11. Demonstrate how to perform a rapid scan of a patient. (pp 275–277, Skill Drill 8-1)
12. Demonstrate the use of a pulse oximetry device to evaluate the effectiveness of oxygenation in the patient. (pp 289–290)
13. Demonstrate the use of electronic devices to assist in determining the patient’s blood pressure in the fi eld. (pp 290–291)
14. Demonstrate how to perform a full-body scan. (pp 291–295, Skill Drill 8-2)
15. Demonstrate how to measure blood pressure by auscultation. (pp 296–300, Skill Drill 8-3)
16. Demonstrate how to measure blood pressure by palpation. (p 300)
